Adaptive Interventions to Reduce Risky Drinking and Violent Behaviors among Adolescents

减少青少年危险饮酒和暴力行为的适应性干预措施

基本信息

批准号：
9080141
负责人：
REBECCA M. CUNNINGHAM
金额：
$ 61.92万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-15 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9080141
关键词：
Accident and Emergency department Adolescent African American Age Alcohol consumption Alcohol or Other Drugs use Caucasians Cause of Death Conditioned Reflex Data Development Drug usage Economically Deprived Population Emergency department screening Emergency department visit Event Future Gender Health Heterogeneity High School Student Homicide Individual Intentional injury Intervention Maintenance Measures Methodology Morbidity - disease rate Outcome Participant Physical aggression Public Health Randomized Reporting Research Resource Allocation Resources Risk Risk Behaviors Severities Specific qualifier value Staging Technology Teenagers Testing Text Time Translations Treatment Efficacy Victimization Violence Work Youth age group alcohol misuse alcohol related consequences alcohol use disorder arm base binge drinking brief alcohol intervention brief intervention comparative efficacy cost drinking behavior efficacy testing emerging adult high risk drinking innovation mortality personalized approach personalized intervention primary outcome public health relevance randomized trial reduced alcohol use response secondary outcome socioeconomics trial design underage drinking

项目摘要

DESCRIPTION (provided by applicant): Underage drinking and violent behaviors (i.e., physical aggression) are prevalent among adolescents and emerging adults, with enormous impact on morbidity and mortality, particularly among youth residing in socio- economically disadvantaged urban settings. An urban Emergency Department (ED) visit provides an opportunity for identifying youth involved in these comorbid risk behaviors and delivering interventions to alter risk trajectories. Despite promising findings from our prior work (the SafERteens Study), which demonstrated the efficacy of an ED-based brief intervention (BI) for alcohol and violence on reducing alcohol-related consequences and violent behaviors, the public health impact of single session BIs is limited by modest effect sizes. Further, there is a critical lack of data regarding how to optimize interventions to have maximal impact with parsimony of resources. Sequential, multiple assignment randomized trial (SMART) designs provide an innovative methodology to compare the efficacy of just-in-time adaptive interventions [(text messaging (TM) or remote health coach (HC)] for adolescents based on response/non-response. To date, such personalized adaptive interventions have not been applied to risky drinking and/or violent behaviors among youth. The proposed study harnesses technology which is particularly appealing to youth, for facilitation of just-in-time delivery of adaptive interventions (AIs). Thus, the specific aims are to: 1) Compare the efficacy of AIs that begin with BI+TM vs. BI+HC on reducing alcohol misuse and violent behaviors among youth while in the ED; and, 2) Identify the most efficacious second-stage strategy post-ED visit for those who initially respond and for those who do not. Specifically, 700 youth (ages 14-20) in the ED screening positive for alcohol use and violent behaviors will be randomly assigned to: BI+TM or BI+HC. After receiving the SafERteens BI in the ED, youth will complete weekly text assessments over an 8 week period to tailor intervention content and measure mechanisms of change, with one month determination of participant response (e.g., binge drinking, violent behaviors). Responders in each arm will be re-randomized to continued condition (e.g., maintenance), or reduced condition (e.g., stepped down). Non-responders will be re-randomized to continued condition (e.g., maintenance), or intensified condition (e.g., stepped up). Outcomes will be measured at 4, 8 and 12 months post-baseline. The AIs will be packaged to maximize future translation, with cost data provided (e.g., total implementation cost, cost per event averted). Secondary aims are to: 1) Compare and contrast pre-specified embedded AIs in terms of primary and secondary outcomes; and, 2) identify baseline and time-varying moderators of AI efficacy. Given the morbidly/mortality associated with alcohol use and violence, the proposed study will have significant public health impact by embedding a comparative efficacy study, testing state-of-the- art intervention delivery approaches (text messaging, remote therapy), within a SMART design to identify the optimal intervention strategy to produce and sustain outcomes among at-risk youth.

描述（由申请人提供）：未成年人饮酒和暴力行为（即身体攻击）在青少年和新兴成年人中普遍存在，对发病率和死亡率产生巨大影响，特别是在居住在社会经济弱势城市环境中的青少年中。尽管我们之前的工作（SafERteens 研究）取得了有希望的结果，但这次访问提供了一个机会来识别参与这些共病风险行为的青少年，并提供干预措施来改变风险轨迹。虽然基于 ED 的酒精和暴力短期干预 (BI) 旨在减少与酒精相关的后果和暴力行为，但单次 BI 的公共卫生影响受到适度影响，此外，严重缺乏关于如何减少酒精相关后果和暴力行为的数据。优化干预措施，以最大限度地减少资源的影响序贯、多重分配随机试验 (SMART) 设计提供了一种创新的方法来比较即时适应性干预措施 [(短信 (TM) 或远程健康教练 (HC)] 的效果。 ) )] 对于青少年来说，基于迄今为止，这种个性化的适应性干预措施尚未应用于青少年中的危险饮酒和/或暴力行为。拟议的研究利用了对青少年特别有吸引力的技术来促进及时提供治疗。因此，具体目标是： 1) 比较人工智能的功效 BI+TM 与 BI+HC 在减少青少年在急诊室期间酗酒和暴力行为方面的比较；以及，2) 为那些最初做出反应和没有做出反应的人确定急诊就诊后最有效的第二阶段策略。急诊室中酒精使用和暴力行为筛查呈阳性的 700 名青少年（14-20 岁）将被随机分配至：BI+TM 或 BI+HC 在急诊室收到 SafERteens BI 后，青少年将被随机分配至 BI+TM 或 BI+HC。在 8 周内完成每周文本，以定制干预内容并衡量变化机制，并在一个月内确定参与者的反应（例如酗酒、暴力行为）。、维持）或减轻条件（例如，降低）将被重新随机分配到持续条件（例如，维持）或强化条件（例如，加强）。成果将在基线后 4、8 和 12 个月进行衡量，以最大限度地提高未来的转化率，并提供成本数据（例如，总实施成本、每个事件避免的成本）。并在主要和次要结果方面对比预先指定的嵌入式人工智能；2) 确定人工智能功效的基线和随时间变化的调节因素，考虑到与酗酒和暴力相关的发病率/死亡率，提出建议。该研究将通过在 SMART 设计中嵌入比较功效研究、测试最先进的干预实施方法（短信、远程治疗）来确定最佳干预策略以产生和维持结果，从而对公共卫生产生重大影响。 - 风险青年。